Review article. Revisiting community participation

Abstract

Community participation in health is a complex entity that has been examined extensively in the literature and continues to be of great interest among community health workers. The genesis of the idea and its conceptual development are primarily attributed to large multinational health institutions, particularly the World Health Organization. However, the implementation of community participation is the ultimate responsibility of local health programme initiators. It is therefore at the local level where day to day realities of incorporating community participation into health service delivery are confronted. This paper reviews the value of community participation in health and provides a detailed examination of the challenges facing its implementation and sustainability. In 1978, the World Health Organization placed community participation squarely at the centre of their strategy to achieve Health For All By The Year 2000. As the year 2000 nears, it is time to critically re-examine the notion of community participation and the most pressing challenges to its viability.

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

“…In contrast, community participation has been extensively conceptualised and analysed in the broader literature on health (Morgan, 2001;Rifkin, 1986Rifkin, , 2009Zakus & Lysack, 1998). Rifkin (1986), points to three main approaches to community participation in health programmes: medical; health services; and community development.…”

Healthy Cities: Facilitating the Active Participation and Empowerment of Local People

“…24,35 As Wallerstein argues, "empowerment… [is] an important outcome in its own right, and also an intermediate outcome in the pathway to reducing health disparities and social exclusion," 29(p18) -a point reiterated by Hothi, who suggests that "empowerment 'done well'… helps individuals and communities to exert control over the circumstances that affect their lives, thereby improving local well-being." 47(p55) Guareschi and Jovchelovitch 48 have commented that participation for empowerment not only serves a conscientization role, but also "re-shapes the relationship between individuals, community and the political arena, empowering, developing citizenship and forging spaces for the presence of grassroots in the institutional structures of the state."…”

“…8,26,29,34 Towards Effective Community Participation and Empowerment It is widely appreciated that effective community participation and empowerment need to be practised coherently and connect spheres of action. 24,35 With reference to Healthy Cities, it is suggested that this should involve: support for community-level action and capacity-building; strengthening of infrastructures and networks; and meaningful organisational development and change. 36 Community participation operates at different levels and embraces a range of practices, as conceptualized by the ladder/continuum, popularised by writers such as Arnstein 37 and Brager and Specht 38 (see Figure 1).…”

Visión de los diferentes agentes sociales sobre la participación social en el sistema de salud en el nordeste de Brasil: una aproximación cualitativa

“…El reconocimiento de la ciudadanía, que se considera fundamental para la participación social en salud 24 , y la cultura de participación, se construyen dentro de la experiencia histórica de los pueblos 6,15,23 . Estos resultados parecen reflejar el curso de la historia de Brasil, marcado por regímenes autoritarios y por la negación de derechos políticos, civiles y sociales que dieron lugar a una sociedad fragmentada 15,23 .…”